Refurbishing damaged health facilities after the conflict in Côte d’Ivoire
Approximately 200 000 people have been displaced within Côte d’Ivoire by the post-election fighting. The most recent figures indicate that 186 000 are in the western Montagnes and Moyen Cavally regions, 71 800 in central, north and east Côte d’Ivoire and 56 000 in Abidjan. The revised Emergency Humanitarian Action Plan sets a scenario of 5.7 million people at risk in the west and around Abidjan. Security varies from one area to the next but the most affected at the moment are the south-western Bas Sassandra region, where severe violence precludes humanitarian access, and Abidjan, where looting continues affecting health structures and injuries are reported daily in hospitals.
Serious risks to health in the west
WHO conducted a mission to Montagnes and Moyen Cavally to assess the effects of the conflict on the health network and the ensuing risks to public health. The assessment showed that 52% (55 out of 106) of the health centres and five of the eight hospitals were no longer functioning due to lack of staff (58% of gynaecologists and surgeons, 72% of doctors and 78% of midwifes were absent), looting and/or partial or total destruction. Half the district pharmacies have been looted, ambulances have disappeared and disease surveillance has been interrupted.
Approximately 30 000 IDPs are reported at the catholic mission in Duékoué where sanitation is inadequate and safe drinking water insufficient to cover their needs. Many more IDPs have found refuge in Guiglo and Danané or with host families. Living conditions have worsened, particularly for women, children, older people and persons living with HIV. An interagency assessment conducted in February revealed that more than half the water pumps in Montagnes and Moyen Cavally regions are out of order. The same assessment showed that up to 60% of the population had no access to latrines.
All those factors are putting the population at great risk of diarrhoeal diseases – including cholera – one of the main causes of morbidity in both regions together with malaria and acute respiratory diseases. Between 16 and 22 May, 16 suspected measles cases were diagnosed on IDP sites in Duékoué.
In order to re-establish access to health care for displaced and host populations in the west, WHO signed agreements with Save the Children, COOPI, the International Rescue Committee (IRC) and Caritas for the organization of mobile health services in and around Guiglo, Toulepleu, Bloléquin and Zouan Hounien.
WHO will provide medicines, medical supplies and cash to the NGOs who will conduct daily missions to specific locations and ensure the provision of primary health care. Up to 16 teams will deploy everyday to reach out to the greatest possible number of people. The arrangement is planned for a duration of three months, until national health authorities can resume routine services.
Since 2 May, a WHO epidemiologist deployed to Man has begun collecting data for the surveillance of selected epidemic-prone diseases: diarrhoea diseases (cholera), meningitis, measles, acute flaccid paralysis and hemorrhagic diseases ( yellow fever). The surveillance system also monitors cases of sexual violence. The epidemiologist will focus particularly on locations where high numbers of IDPs are gathered, such as Duékoué, Guiglo and Danané. The teams deployed by Save the Children, COOPI, IRC and Caritas also report to the surveillance system. The surveillance system is being expanded to Abidjan and Bouaké.
In Abidjan, most health facilities visited by WHO are functioning. However, two of the 11 health structures in Yopougon East have been destroyed while another two are occupied by armed groups. Insecurity also persists in Attécoubé Health District where health structures have been looted. The supply of medicines in facilities unsupported by humanitarian partners is difficult. Access to health care for patients living in the periphery of Abidjan is very limited due to insecurity. The central pharmacy has a limited supply of stocks.
WHO, Health Cluster partners and the Government will review the needs for the redeployment of national health staff and the rehabilitation of health equipment and facilities, and conduct a complete inventory of medicines available in the country.
WHO will provide logistics support, including communication and computer equipment to enhance Health Cluster coordination.
WHO has provided US$ 200 000 from its own resources to initiate the project. However, medical supplies available in the country office are insufficient to cover all the needs. More funds will be needed to purchase additional health kits. WHO will participate in a briefing meeting with donors organized by OCHA at the end of May.